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As the largest independent city in America, Baltimore, Maryland, has a lot of peculiarities and a lot of history. From the Battle of Baltimore during the War of 1812 that prompted Francis Scott Key to write the National Anthem, to the odd way in which the locals pronounce the “O” (“Owe say can you see…”) Baltimore has always been an engaging city. Edgar Allan Poe rests peacefully there as his woeful poetry lingers on, but the current state of Poe’s beloved Baltimore would disturb even him.

One of the reasons for an increase of overdoses in Baltimore is that the drugs are of a much purer quality than the national average, according to the DEA.

Though once nicknamed “Charm City” for the artsy and vibrant culture, Baltimore’s eclectic neighborhoods are now peppered with vacant and burned-out houses. Gritty portrayals of the city, like in HBO’s The Wire are all-too-accurate as they depict drive-by shootings and gangs running the neighborhoods. No one is refuting Baltimore’s dangerous reputation. “Bodymore, Murdaland” had the fifth highest murder rate in the nation as of last year, but it is now being plagued by a very different epidemic: heroin.

With an estimated 60,000 addicts among its streets, the city of Baltimore is being consumed by a devastating drug known for destroying the lives of its users, and those left to pick up the pieces. This number suggests that one in 10 Baltimore residents are addicted to heroin, a statistic that reflects Americans’ overwhelming shift from prescription drugs to the cheaper alternative.

While some remember the '90s as being "heroin chic," this drug was then considered much too unorthodox for some, and too impractical for others. Instead, opiates like OxyContin and Percocet were an especially popular choice for people in rural areas of the United States to get high. Known as “hillbilly heroin,” these pills were easy to acquire, and prices were fairly manageable for working class Americans who suffered from addiction problems. Today, however, these pills typically sell within the $50-60 range and many users, unable to afford the surge in prices, turn to heroin.

As prescription drug addiction continues to rise in America, where patients are routinely overprescribed narcotics, opiate dependency has led many to try heroin and even adopt it as their drug of choice. Buying a $20 bag of “dope” (sometimes of a relatively pure consistency) makes a lot more sense to drug users who often spend three times as much per pill.

And with the number of both heroin consumers and dealers growing every year, lower income neighborhoods, like many found in Baltimore, are particularly vulnerable to high drug activity. The city’s overall poverty rate is just above 25%, leading a large amount of its citizens to enter the heroin business and cash in on this new trend.

By sitting firmly in the middle of the East Coast, the geography of Maryland itself makes the state an easy target—a quick stop for drug dealers shipping their product up and down the coast. Most of Baltimore’s heroin enters the city this way, but the famous Port of Baltimore serves as a particularly convenient pathway for international drug smuggling.

The Port of Baltimore was established in 1706 as a port of entry for the tobacco trade with England. It was originally designed to accommodate the largest of shipping vessels, but today these are often stuffed with massive loads of illegal narcotics. For instance, in 2013, custom agents seized 128 pounds of cocaine that was shipped to the Baltimore port from Panama and China.

Fresh off the boat, these drugs are funneled right onto city streets by the thousands of dealers eager to make a profit, and the city’s war on heroin rages on.

As Baltimore’s addict population continues to grow, the media has taken notice.

The National Geographic documentary series Drugs Inc. recently aired an episode entitled, “The High Wire” that highlights Baltimore’s heroin problem. Showing junkies shooting up on the streets in broad daylight and drug dealers peddling at Lexington Market just a few feet from police, this show emphasizes the fact that a greater police presence does not seem to offer much of a solution.

Some, however, say that the National Geographic program sensationalizes the issue and does not accurately reflect Baltimore’s problems with drugs. In a Baltimore Sun article, David Zurawik disagrees with the number “60,000” saying:

“Second, the 60,000 number has never come close to being confirmed. The Sun tried to do so twice—in 2005 and, again, in July—and concluded that 'it likely emerged from a blend of best guesses and misunderstandings' dating back to at least 1986.”

However, a report by the Drug Enforcement Agency in the year 2000 stated that Baltimore had the highest per capita rate for heroin use in the entire country, and 15 years later, this still rings true.

With statewide overdose deaths attributed to heroin increasing by 88%, Governor Larry Hogan labeled it a “State of Emergency” in response, saying:

To date, Maryland has not yet declared a “State of Emergency” and it is not clear why. Massachusetts and New Jersey have already done so, with Governor Christie organizing a special task force to address the problem.

In the meantime, Hogan’s speech has drawn a lot of public attention to the issue, and the state has followed Christie’s lead on assembling a special task force, to be led by Maryland Lieutenant Governor Boyd Rutherford. Additionally, recent efforts to prevent heroin distribution in Maryland include joining a six-state coalition to target a supply line of the drug along the East Coast, as New York and New Jersey provide nearly a quarter of the heroin found in Baltimore.

Many of the proposed solutions, including attempts to arrest more dealers, center around the idea of prevention. Lately, however, the bigger concern is the shocking number of overdose deaths in Maryland, and Baltimore, in particular. In 2013 alone, the city experienced over 300 fatal heroin overdoses, and an even higher number of emergency room visits.

One of the reasons for an increase of overdoses in Baltimore is that the drugs, most commonly originating from South America, are of a much purer quality than the national average, according to the DEA. Buyers consider themselves lucky to be given “raw” clean dope and reputable dealers make a point to cut the drugs with very little else, if at all.

Some dealers, however, maximize their profits by cutting the powder with substances like Fentanyl—a synthetic opiate that is approximately 15 times more potent than heroin. Users have no way of knowing what they are snorting, smoking or shooting into their arms, and many suffer the fatal consequences.

Thankfully, though, Maryland police have recently been required to carry the lifesaving medication, naloxone—a drug that can reverse the effects of an overdose. Quincy, Massachusetts was the first place in the United States to carry naloxone and it reportedly saved 230 lives in just four years.

Yet, even with the newly implemented law requiring this tool, many addicts fear being arrested more than the idea of death itself and are therefore reluctant to call for help. Although ingesting a substance is not necessarily cause for arrest, many know from personal experience that anything resembling heroin paraphernalia or drug residue means serious trouble in the eyes of the law. The much debated War on Drugs is not inspiring people to seek help for their addictions or even save their own lives as America has been conditioned to view addicts as criminals first and disease sufferers second.

One medicine that is far more commonly given to heroin users is the controversial drug methadone, and some clinics in Baltimore hand it out to scores of addicts amidst their personal horrors of withdrawal. As opiate-addicted patients eagerly wait for their medicine, their dependence on heroin lessens as their dependence on methadone increases. While the severity of addiction prevents a lot of these recipients from ever weaning off of opiates entirely, methadone has proven extremely beneficial, just in terms of harm reduction. Addicts that were previously nodding out at work and subsequently fired can suddenly find themselves able to live something resembling a normal life. Suburban women, now considered the "new face of heroin," can come one step closer to overcoming their addiction, and stop having to smuggle Baltimore street drugs in their minivans.

Other substitutions for heroin like Suboxone, the orange strips that dissolve synthetic opiates into your bloodstream, are also considered beneficial in treating heroin addiction. Baltimore physicians are prescribing more Suboxone than ever before, and many drug abuse clinics report on the success that this treatment can provide for struggling patients. Still, a large percentage of people are unable to ever quit these alternative drugs, and clinics administering them are routinely questioned—often leaving these facilities short on necessary funding.

Aside from the chemical dependency aspect of addiction, researchers are also focusing on improving mental health care for addicts. Treatment centers like Baltimore’s Glass Health Programs describe therapy as an essential tool for recovery, in addition to offering medication assistance.

Whereas Maryland was once able to rely on organizations like AA and NA to provide recovering addicts with this type of service, the state’s current crisis reflects the growing need for more mental health centers focusing on substance abuse and recovery. Although Maryland’s task force plans to address the problem as a state-wide concern, Baltimore still remains the biggest obstacle in fighting Maryland’s heroin epidemic. As public opinion remains divided on how to aid the heroin capital of the United States, many are left wondering: what more can be done?

Julia Beatty is a student and freelance writer in NYC. You can follow her on Twitter @juliabeatty1.

The gritty city that was the real star of The Wire is now being plagued anew.

In the face of what has become a prescription opioid and heroin epidemic, states across the country are looking to legislate against these drugs, limiting or even eliminating their use. That might bode well for acute pain sufferers, but not for those with chronic pain. Fortunately, scientists are working hard to find more efficacious, and less addicting, drugs to treat pain.

History of using opioids to treat pain

The opium poppy has been used to treat pain for over 3,000 years, and it’s the best medication we have for acute pain—anything that lasts from a few seconds to a few weeks. “Most of the analgesics employed today are opioids related to morphine that were developed over 50 years ago,” says Dr. Philip Portoghese, a medicinal chemist at the University of Minnesota. “They are effective in reducing acute pain, but upon prolonged exposure, tolerance and dependence develops—thus, they are not ideal medications for treatment of chronic pain.”

Chronic pain is a different animal. Chronic pain can last for months, years, or a lifetime. The problem with using opioid-based drugs to treat chronic, or lasting, pain is that the accompanying high can become addictive over long-term use. And, the longer you use opioids, the more you need to use because you become tolerant to the drug’s effect—which in turn promotes dependence and addiction. Chronic use of opioid medications can also cause one to become more sensitive to pain, thus perpetuating increased need for these drugs.

“This is becoming ever more apparent as our population is aging, increasing the number of people with arthritis, chronic back pain, etc.,” says Dr. Ajay Yekkirala of Children’s Hospital Boston and Harvard Medical School. “All of these problems require a new paradigm for pain therapy—drugs that are devoid of [these] side effects.”

How do current opioid medications work?

Opioids actually occur naturally in humans, and these endogenous molecules act on opioid receptors in the nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. The receptors come in three major subtypes—mu, kappa, and delta—a fact that affects how the opioid binds and therefore, the effect it elicits. Our current synthetic opioid painkillers are mu agonists, which means the drug mimics the effect of an endogenous opioid molecule by binding to the mu receptor, activating it, and sending a signal to the body that reduces the effect of a painful stimulus.

The side effects seen using today’s synthetic painkilling drugs—which are based on “the prototypical analgesic, morphine,” Portoghese says—are because they activate the mu receptor. However, kappa and delta receptors have their problems, too. While they provide relief and are considered better in terms of not promoting as much of an addictive response, patients can experience “dysphoria or psychotomimetic effects—where patients hallucinate and many complain of feeling like they are dying,” Yekkirala says. “Several delta ligands also produce tolerance which leads to dose escalation and a slew of other problems,” says Portoghese. “Analgesics that target delta selectivity have been reported, but none are presently clinically employed.”

While there have been steps to reformulate existing drugs—FDA approved an “abuse-deterrent” version of OxyContin in 2013 that is slow release, and Pfizer now sells a short-acting version that has been designed to burn the nose if snorted—this is only sidestepping a larger problem. “Abuse deterrent formulations do have a huge impact on their abuse: It will minimize—[but] never eliminate—abuse of the prescription meds,” says Dr. Andrew Coop, chair of the department of pharmaceutical sciences at the University of Maryland School of Pharmacy. “The downside, as is already being seen, is the rise in heroin use again.” Yekkirala says that this approach feels more akin to a “Band-Aid, while coming up with a drug that is completely devoid of the addictive potential to begin with seems to be the superior long-term approach.”

New targets

There are several ways that research is targeting new drugs. One is by designing variants of the opioid receptor. In this method, mutations leading to opioid receptors that are formed slightly differently—called splice variants—can bind opioids differently. However, these are early days, and they are not well understood.

Another method is targeting not mu, but delta and kappa opioid receptors. Unfortunately, there are side effects, and in some ways, Yekkirala says, they’re “not as effective as mu ligands for analgesia.”

A third is targeting multiple receptor subtypes (turning one on, the other off). Portoghese was one of the first to show that activating mu while blocking delta reduces the development of tolerance. “That’s my approach,” Coop says, whose team has developed a drug, UMB 425, that does just that. “[It] appears to be strictly mu agonist, delta antagonist.” Simultaneously giving a delta antagonist reduces the development of tolerance to the mu ligand. Kappa, he says, doesn’t seem to have an effect on mu.

Portoghese’s work also shows that opioids’ effects are more complex than imagined. Not only can opioids bind complexes that consist of two opioid receptor subtypes (mu and delta, for example), but they can also bind complexes that consist of multiple receptors. Hence, a fourth new method is targeting multiple receptors that are not necessarily opioid. Promising pre-clinical studies have shown that targeting the mu receptor bound to either the metabotropic glutamate receptor 5 or the cannabinoid receptor type 1 can effectively diminish pain.

A fifth is called functional selectivity, or agonist trafficking. “It’s where all agonists are not the same” in terms of what signaling message is sent through the cell. “An agonist binds to the outside of a receptor, passes a message, which activates second messengers inside the cell,” Coop says. “If the agonists activate different second messengers, then they will have different effects.” There is much research looking into this method.

Less conventional, but still promising, approaches are targeting glial cells (which are found in the brain and act as immune cells, not neurons), cannabinoid receptors, capsaicin receptors, as well as the sodium and calcium channels that are embedded in the cell membrane. “Each has benefits and major issues,” Yekkirala says.

New drugs in the pipeline

Currently, there are about a dozen drugs being developed to replace addictive, painkillers like OxyContin. One of the most well publicized is Cara Therapeutics’ CR845, which works on kappa instead of mu opioid receptors. The Connecticut-based company recently released research showing its opioid drug is far less likely to cause patients to feel high. What’s different about CR845 is that the drug is “peripherally restricted,” or, it’s too big to cross the blood-brain barrier. “That way you can get pain relief in the extremities, but will not get the dysphoria usually elicited by kappa receptors in the brain,” Yekkirala says. While it’s a “great idea in theory, the jury is out on how effective this approach will be for various types of pain, especially because chronic pain usually involves something called “central sensitization,” Yekkirala says, which occurs in the central nervous system (brain and spinal cord). “It will not treat severe pain,” Coop says, citing another drawback.

Coop’s own lab has come up with UMB 425, which is a drug that works as an agonist on the mu receptor and an antagonist on the delta receptor. He says it’s been shown to both reduce tolerance in mice taking morphine chronically, which contributes to less side effects, and reduce dependence, “which has huge implications for becoming addicted to the drug.” They are currently repeating the studies in rats, along with looking at UMB 425’s ability to cause dependence. “This compound has the potential to replace all other opioids on the market, with no need for abuse-deterrent formulation as it would not have potential for abuse,” Coop says.

Portoghese’s lab has developed two notable compounds, MMG22 and NNTA. MMG22 works on a mu opioid-metabotropic glutamate receptor 5 (mGluR5) complex, which has “great potential” for lower tolerance, Coop says. The compound is meant to activate mu and turn off mGluR5. It has been shown to block pain associated with bone cancer and treatment of bone cancer in mice. “MMG22 has unprecedented potency and does not produce tolerance,” Portoghese says.

NNTA works on both the mu and kappa opioid receptors and is meant to bind specifically to this complex.

“I think these ligands bear testimony to the fact [that] targeting such receptor complexes can make effective painkillers without some of the major side effects,” Yekkirala says. “For instance, NNTA is 50 times more potent than morphine and produces no physical dependence or drug-seeking behaviors in rodents.” They are actively developing a version of these drugs that can be used clinically. (Yekkirala first-authored the NNTA paper with Portoghese, and he is currently in the process of co-founding a startup around NNTA and other non-addictive pain medications.)

Future focus

All interviewed believe that doctors will eventually end up prescribing pain medications based on genetic makeup. Predicting who will respond and how he or she will respond to a particular drug is the holy grail of personalized medicine, and it seems especially useful in the context of how to treat pain in an addict or recovering addict.

Some recent findings of mutations for pain tolerance and neuropathic pain, “[give] us an idea for what to look for in individuals,” Yekkirala says. “Lots more to unfold and understand here, though—I wouldn’t hold my breath. But rest assured, this may very well be how future approaches will go.”

The journey to recovery is not easy. It is a road paved with many obstacles that can trip you up and lead you back to drug use. Whatever happens in life for addicts, whether good or bad,relapse is always an option. But to maintain sobriety, an alcoholic or chemically dependent person must buy into the fact that relapse is not an option. To live clean and sober is a battle that a former user must fight each and every day while temptation rears its ugly head as you fight down the demons of yesteryears. We hear a lot about the failures and the problems with addiction and drug abuse in society as a whole but what about the successes? Recovery should be celebrated, but not with a glass of champagne.

Success in recovery should be equally applauded. It is a path not often taken or achieved. Most addicts are just happy to be off the drugs. Being successful in life takes recovery to a whole other level. But the truth remains that you can never forget where you came from. Hitting rock bottom and coming to the realization that you are in the throes of addiction is a life-changing recognition. The first step of overcoming addiction is to admit that you are powerless. That is something Stephen Sutler does everyday.

In the eyes of a former drug addict, the simple family life is a dream and a life well worth living.

“Addiction has always been in my blood since I was a kid,” The 30-year-old Missouri native tells The Fix. “I remember my first addiction problem was food because I used to be an overweight kid. Once I got to be about 12 or 13 and got my hands on something besides food, like marijuana and alcohol, it was over.” Addiction is a progressive disease and many people suffering from it trade one addiction for another.

”I went through my teenage years abusing hallucinogens, alcohol, acid, ecstasy, and marijuana,” Stephen says. “It just fueled my addiction and I grew up replacing one addiction for another. Everything was all right for awhile with the drug use and school. And as a teenager, it was kind of acceptable but as people transitioned out of that lifestyle and started getting serious about school and stopped experimenting, I started stepping out of school and deeper into the experimenting. I was 16 when I first used meth with my father out in Las Vegas. I spent a year and a half out in Las Vegas and probably didn’t sleep more than a week or two, it felt like. That was the nail in the coffin, if you will.”

Like so many addicts, Stephen couldn’t control his usage. He dove into the drug world headfirst and immersed himself in the culture. There was no caution for Stephen, everything was balls to the wall. No moderation, only excess, the true mark of an addict. But, there is no brand or identifier. The only thing that sets an addict apart is their non-stop drug use and abuse; the urge to use despite the destruction of their life.

“It just went from one thing to the next,” Stephen tells The Fix. “I came back to St. Louis and hooked up with some people that were manufacturing. I started involving myself in that lifestyle and started cooking meth and running the streets.” The downward spiral so common with addiction was in full swing. It would take something drastic for Stephen to stop. He was in a free fall.

“In the process I burnt all my bridges, lost the trust of my family, and lost the privilege of living under their roof,” Stephen relates. “Eventually, I just bounced from couch-to-couch, living out of a little Ford Escort with a smashed out back window and a meth lab in the trunk. Staying up for weeks at a time and sleeping in my car or on somebodies couch. It was just a cycle of self-destruction and self-hatred that was fueled by my past and all of the poor choices I made. It just turned into a complete disaster.”

In the grip of methamphetamine, Stephen only had one mission in life—to get that next hit. His involvement with meth led to a 2010 federal manufacturing charge and instead of getting cleaned up, Stephen went in the opposite direction and continued on his path to self-destruction like so many other addicts. He amped up his drug use by shooting heroin. It was the beginning of the end for Stephen as the junkie’s nightmare consumed him.

“I quickly dove into heroin and I spent the better part of 2010 and 2011 shooting heroin three or four or five times a day,” Stephen says. “I was on federal probation at the time, under a signature bond and they were watching me. It took them almost two years to federally indict me and on February 27, 2011, I [would] shoot my last dose of heroin in my arm, driving 70 miles per hour down the highway right by the St. Louis Arch. I overdosed and crashed the vehicle into pieces all over the highway. They found me dead behind the wheel. Not from the accident, [but] from the heroin. They had a chance to deliver medicine to bring me back and reverse the effects of the opiates. Then they took me straight to the hospital and handcuffed me to the bed.”

A lot of people would think this was the end of Stephen’s story—addiction, overdose, death and jail. But this was Stephen's awakening. He had hit rock bottom. Now, it was time to put the pieces of his life back together.

“I hit my rock bottom so many times in my life that I always thought it can never get any worse than this, but at that moment, when I was laying in that hospital bed I said there is no way I can continue doing this,” Stephen tells The Fix. “I’ve got to find some other way to live my life or I’m not gonna live my life. I was just sick and tired of it. I couldn’t do it anymore. I just set out to change everything about me. I knew no way possible to live a life free of drugs and alcohol. I didn’t understand how to do it. I didn’t think it was possible. But I did know that I had to find some other way.”

Like many stuck in that "between" state of addiction, Stephen wanted help, but he wasn’t sure where to start. And to make matters worse, he was going to jail. His drug use had led him to a harrowing conclusion: a 42-month federal prison sentence for conspiracy to possess Sudafed with intent to manufacture methamphetamine. Sitting in a jail cell after his hospital stay, Stephen made a plan to get and stay clean once and for all; he wanted to get his life together. He knew the most important thing was to stay drug-free. But he wasn’t sure how to do it.

“I had some spiritual beliefs, but being on drugs and being in that lifestyle, God is the last thing on your mind until you sober up and you cry out, 'Why the hell am I doing this to myself? Why the hell is my life like this?'” Stephen says. “I really just dove into breaking myself down to a real basic level of what three things would cause me to feel stable enough to make it through each day. I just focused on physical health, mental health and spiritual health. I worked on those three things everyday, just to feel like I could make it through each day. If I tended to those three things each day, I felt a little bit more sane and a little less addicted. I built off that.”

Stephen Sutler

Eventually, Stephen enrolled in the BOP’s Residential Drug Abuse Program (RDAP) even though he didn't get anytime off for completing the program. “I thought there was probably some more tools I can use that were practical knowledge,” Stephen tells us. “Like things in your head and things in your mind about how to change the way you view things and think about things. I needed to change my perception in life. I didn’t really have any guidance to get pointed in the right direction. I went with this spiritual inner kind of path by myself and I was interested in what they had to offer.” After completing the program and being drug free for his entire incarceration, he was ready to reenter society—clean and sober for the first time in his adult life.

“I got to the halfway house and I got a job right away,” Stephen says. “I had really good family support because they wanted to see me succeed and they were so happy to see me clean and sober. It was a little hard to stay on course after being out of the world for so long. A lot of temptations, not to use drugs so much, but just to be out and involved with people and enjoying life. It pulled me away from the foundation that I had built in prison and I had to continue to balance that out and that was a pretty hard struggle.” But Stephen found something new to use as a center to his recovery.

“I have been involved in my church,” Stephen says. “I did the NA 12-step program before, but now I am more into my church and have surrounded myself with people that have good morals, values, integrity and dignity. I have stepped into Celebrate Recovery, which is a God-centered 12-step program. They have basically the same 12 steps, but they are based on the Bible.” Besides his continued recovery, Stephen has immersed himself in his work and family affairs.

“The biggest thing that helped me was that I met a man in St. Louis, Frank Papa, who owned a restaurant and he gave me an opportunity to put my foot in the door as a buser,” Stephen says. “I never worked in a restaurant before and this place was a fine-dining establishment. He gave me an opportunity and I took it and I ran with it. I worked hard and he let me step up to be a server in the restaurant.” Stephen was grateful for his second chance at life and he worked hard at it.

“That opened up another opportunity for me at one of the finest restaurants in St. Louis, Cafe Napoli, as a server,” Stephen says. “That's the key thing for ex-offenders reentering society, just that one opportunity to prove themselves and get their foot in the door. Frank Papa gave me that opportunity and I never looked back. Cafe Napoli gave me the opportunity to become knowledgeable and learn about fine wines, sell them and give guests a great dining experience.” But more important to Stephen is the success he has had with his family.

“I had an amazing woman by my side the whole time, even before I went in, and she was my biggest fan and my greatest supporter,” Stephen says. “She stepped right up as soon as I got out and she just wrapped her arms around me with love and supported me and helped me. We just fell right back in love with each other. She has two amazing children. I am blessed to be a part of their lives as a role model and a step-father.” For a man who struggled with drugs and relationships, Stephen relished the opportunity to be a parent.

Stephen and Selena

“I was able to step into an amazing family with a 12-year-old boy and a five-year-old girl that really love me and an amazing woman who is in love with me,” Stephen says. “I have gotten the opportunity to prove myself and to stand up and be [the] father in a home where there wasn’t one and to be a male role model in a home where there wasn’t one, which was one of the biggest things that I lacked as a child.” Not to blame a missing male role model for his drug addiction, but having two loving and supportive parents can help tremendously.

“I feel that not having a father can be a major deciding factor on whether children choose a good path and make a right decision, or chose to go down the path that I did as a child where it was rough roads and drug use and crime,” Stephen tells The Fix. “With no father figure in the home as a role model, and no loving father that is what can happen. I think it is crucial to have that figure and role model. And I now have the opportunity to give that back to two children that didn’t have that and I can stop the cycle that was my life.”

Therein lies the real secret of his success; a noble and true cause for Stephen. Because success in recovery cannot be made in monetary or materialistic means. Success is measured by quality of life. Stephen is going on daddy/daughter dinner dance dates, mentoring a young man and learning how to fly a plane. All things that he couldn’t have done in his previous life. In the eyes of a former drug addict, one who faces his demons everyday and keeps them at bay, the simple family life is a dream and a life well worth living. Overcoming drug abuse and living in recovery can be a success. It is just up to the former addict to define that success.

This Arizona rehab prescribes high doses of AA meetings and backpacking for young guys who not only need to get sober, but also learn the basics (think cooking and cleaning) of living in the real world.

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Alumni rave about Mountainside's Mind-Body-Spirit program which includes activities such as yoga, Four Agreements and acupuncture. They also have two full-time psychiatrists on staff who specialize in addiction medicine.

Anaheim Lighthouse is a drug and alcohol rehab with a more residential feel to it than many of its competitors. The suburban surroundings are replete with palm trees and green lawns, and the houses also have outdoor lounge areas with benches and small decorated fountains.

In addition to the 12-step / holistic therapy approach, what Palm Partners alumni consider the most meaningful part of their stay is the positive relationships built with fellow alumni and a deep love and appreciation of many of the therapists, counselors and techs who work there.

An alternative to 12-step programs, Gulf Breeze Recovery offers panoramic ocean views in a caring and therapeutic environment. Housing up to 26 residential guests, this luxury facility offers a choice of semi-private or private rooms with or without ocean views.